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37-065 (56) File#BP-2006-1286 APPLICANT/CONTACT PERSON LINKER MARCI ADDRESS/PHONE 107 BLACK BIRCH TRAIL FLORENCE (413)584-8817 0 PROPERTY LOCATION UNIT 107-44 BLACK BIRCH TRAIL MAP 37 PARCEL 065 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid FeePemrit Filled out f fYO.,! Fee Paid `7 IN 6° TypeofConstruction: CONSTRUCT NON-BEARING WAIL IN IN BASEMENT New Construction Non Structural interior renovations Addition to Existing. _Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans I Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFGIRMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Pemtit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Pera t from Elm Street .4 "scion /�////// LCH Signature of Building Official Date ////! /� !� Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. °bot„ u' MxM:.y ~rF. City of Northampton �q A'`"l"`., C i. Building Department r•s',e',`Y-°— < fe v , + - 212 Main Street =, -: �-* ,,'�, j Room 100 -a.�.r r �' 'g Northampton, MA 01060 -ia . �` - ' pholie 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION Y•SITE INFORMATION • 11 Property Address: Thissecharcbzlee eosn*tadhyafficp loF�T`7 &&RLL Bict h at rsay xht�' Ono • l C DetI Ce "kg 0 1 p(i)t- ene^,,,�.. :OvedayDIsWL[' 41eiti ce ObMeC SECTION 2•PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: r(t S. LIt1K2r 107 6IaCC 6;tth TGa/1 "t CP 0t0;2. Name(Print) • Current Mailing, rens: 271 )4+� �sri:$6(� Telephone Signature 22 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION'S•ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 70 U O (a)-Building Permit Fee 2. Electrical0. 00 (b)Estimated Total Cost of Constructioafrom(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Tcta1=(1+2+3+4+6) CIO/00 Check Number 2//f()9 This.Section For Official Use Only .__-.. . . .;Date Building Permit Number .,,,•., Issued: Signalize: Building Commissioner/Inspector of Builtlmgs Date Section 4. ZONING An information Must Be Completed.Permit Can Be Denied We To Incomplete Information TbR7sicuiro by Zoning®® Budding Depanment br BillalMEMEMEME Setbacks Front Side 1.1111111 Rear k p Open Space Footage ®®®® (Lot area minus bldg&pared 21 --- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book . Page and/or Document it B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ® , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E Wfii the o>nstr-lotion activity disturb(^clearing,grading,excavation.or Ming)over 1 acre or is it part of a common plan V that will disturb over 1 acre? YES NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. • SECTION 5-DESCRIPTION OF PROPOSED.WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) rvf Roofing in Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [O Siding[O] Other[0] Brief Description of Proposed Work: Add a non-tfvrruraI di:itivyj wall [IA flap liaSev[IaN- For Inc pras-a pelVaty rmrn DW�orS Or Atteration of existing bedroom Yes Na Adding new bedroom Yes No d19 k>< Attached Narrative Renovating unfinished basement Yes i/No Plans Attached Roll -Sheet Earl New4loUS'a -.. r: Itto/To i in4hol i-rermpmmlowing: a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Coriservadon Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes Nb. I. Septic Tank City Sewer Private well City water Supply SECTION 7a--OWNER AUTHORIZATION-TO BE-COMPLETED'WHEN OWNERSAGENTORCONTRACTORAPPLIESFOR BUILDING PERMIT as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. //`/ /Signature of Ownerrn Date "7 I arC.I �--I n rI/te✓ ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties.of perjury. mare , u in ✓ Print Name rr)le i id n . 6-23/o h Signature of Owner/Agent Date • SECTION 8.CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: License Number Address- Expiration Dale • Signature Telephone SSifea"i§Cerbd`Rn"itiei ip�SY�eru®uf+U"astl"4aito"sem-t¢^at• . :e .`?E1-.*r 'A ,z.25 i' Not Applicable 0 Company Name Registration Number Address Expiration Date Telephone_ _ SECTION 10-WORKERS'COMPENSATION INSURANCE.AFFIDAVIT(M.O.L c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ❑ No ❑ tellfig it,S,Y4fire 4:1".MI /47 The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 1083.5,. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.,structures.e p517son who constructs more than one home to a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official that he/she shag be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from.time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature 4. 7',00.PWlPpO \ ,P. Q Ti,i112, of Paifl,ain tno l OEPARTM ENT OP OVzLUooO INSPECTIOer:s (C =4 - ' 212 Main Strand ' Municipal Bonding ` Northampton, Macs. 010G0 WORKER'S COMPENSATION ENSUTtANCF AFFIDAVIT • r-tynr/in art;ttec) with a principal pare of business/residence at: . (S a....Mei tyt ua l r f a p) do hereby certify, under the pans and penalties of perjury; hat ( ) 1 am an employer providing the foilowine worker's comocnszJon coverage For my employees wor?dng on this job _. (Menem Compracy) /Pato Numb_r) CB:pimtior. Date) (✓) [ :ter a sole prooretor, general contractorhomeowael(cPcie oac) ma have hired the contractors listed below tvbo have the fotiosvha worke?s compensation policies }4S Ca(5a. . (NIIIDc of Connaoa (in urine.Company/ 06c- Numzr) hath rdcaa DMC) • (itmc of Cone-actor) (tnnuaoc Company/Policy Numccr) (Expiration Date (Name of Coolsac o:) (Insuranc: Company/Policy Namb:r) (E\pin_don Date) (Name of Conran() ([nsurancc. Company/Policy Numb^.cl (E\'pinfOn Doc) (.a.aa;20y am if teoeva,ry,a-ec'u#atonco pc-*aitio6 v.11 v -va) • () I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. • NOTE'pl.ctwuc LW wCi bao.>'tn..bo ploypc to --....... c= =rca work.m.d.<tn of au Goo.tka 4asyo iu xbid Use nona....tar mid"or m thc IIrw hag sncv—..tbeee LT 174-X C.c3="42)'ecvaaat W be anchor." crr ILa s:_r ataanoottAn(GL152=I(5)).app4caev by.bomm.m fay t bw..a remits/.^` Lbc 1<g.1 r'.u..w:a walay.<wactar Eu Wca..W%f— M. [ A.cr d,b¢a mus f t:.msmea m..y b.t*n .d to w.hap-runt anoat.rrta n..emar Otto.or tm.-,m fn w. oovenc,e'ifetim and Uu C!tat to sworn teveeg +Nr-"x"ioo 2$A arum.157 an k4+c tb:iopstim of cimm-1 lxailtin am+.ceg oft&pc or.gb S1.5O300*Mfcc oo-henwcm of up to ac yrs earl civil p,nto in form of.S Wok ON.ua• f o(SIOO.co.dy.4tir- — Fur 4c,Dtamir —."arc x3Y '�/� �y �y/'r PaNumbor t fl6L -cj `YQ/cf" =_ 6 hely: tat P I df Szgxaturc of i.. . *crmiuc e .. -J H • pSK.Uf• 04. $ (city of Xartitanl}rtan _Tar fir; . € Rt....tq,...n. ` _ iae PA DERTMENT OF BUILDING INSPECTIONS �. INSPECTOR 272 Maul,Sweet • Municipal Building Northampton,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 10$3.4 to act as his/her construction supc: ,isor. The state defines "Homeowner" as, "Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor,to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages,which include foundation/footings (before backfill), sonotube holes(before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed,failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing&gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location LINKER 06 "/ 1 W/12 V=•=u^+u W/12 JRW.ALL 24-0" rE WF fN f(XING WA 1 . ll'tlRG A / -6 A 19-6 j i g4 416:1 .... ... - -. ,/; � _. 15. E �,ti 0 WPM 3 D - d y .„_-� PiatANAT-wr 1— GP.AIANG PLAN 4,1 p, . 4 i n '4 eu a C8 N S'A ?Aos ra pArrrna Ei_5 !,ixflgp wi4-c6 • y N 8 )1 Vii' �.1 ;;:e Ae+GF �( '�. .j,� 9 1 / 6. UNFINISHED ,t E41 'rn9€MSN� ¢4 i1. 1 125'.. A f Pi Q / r k E}ea :Kr �s or (trr Flo©r • �,�( n1 � ._ 11 1 I ---<- -- --* // 1: ct , et .,4tOaer ia ! \\,:-.--------.'7".--___:, -lit, / � £ ct, 4e/2\26r- tl k,l H 7 , , r ___ __, �_ _ 2 '', SAGE"'ENT PLAN Cly /7 ` i h o UNIT 7-8 r � N7k ( NS�itJr Tl �hl7atc: ""w 'l9 [OUSINC " 3.�' '9 Prop,c1 +u (12 (3; SECOND FLOOR/ AT—IC �� , to ,04EP. - M t-Ar �.Ai <FF NF` Drawn II‘ k: M. MA "aac cclow 1 -reet - 12s Locust Street sq I ecIeisA ?QS' Northampton,MA 01060 Backflow PreventionfDevice Design Data Sheet Application for Installation Owner's name -ler,= %"(G 4i5Ik f' Address CO .... PGC. Telephone number ✓ Facility Name RCe..C.'-E I-4+It L.o Vex2ki cjl a012 0.2bn Address %Oct &.Inn ,. tut seesn pie. 4LoE.eic f/po� oCt-Yra..,pl'b+l _ Contact personiagcnt_,-iaft". tiC/1 Telephone muuber of facility contact person_4(3.- '>�(..a =.ZS9.7 • New facility (.tS Exisfing facility General de tion for the need of the installation of a backflow device _F Ya 1cct tan `S s be,6- _._... Device Data Manufacturer name AM1=S Cofer("' Model No, C ZOO RPB? or Doable Check Valves v.--"*" Size 4" Hot or cold water unit„Cola- ,._By-pass arrangement Yesor No Exact location of device + m.. ______ Watci usage down stitaln of device roesi hScrrgn 54Zt Gate valve „»Bahl valve Butterfly valve Plans and Spare Parts Required The installation contractor is responsible for supplying a snare fufibcr parts kit for each device A fully labeled,detailed schematic of the potable and non-potable water piping nxnediately surrounding the barkfldw prevention device installation showing: 1. Height above floor of the device 2 Distance from wall of the device 3. Type of cbcmicat(s)used(if any)and the type of equipment upstream, and downstream of the device Please note block:The schematic drawing must be at least 8'AbyT}i it td3wftt ifie0- Irftyin� \ information in comnhetcd tR the e block. t \sL �'.. Submitted by: v Mmnber's signature: 1 .. `A ,^i 1 i ,er0 Plumber's license it Ownerfagent signature: L —. Date: Prr n !MS I Y in 070f9 All information listed above must be included on schematic drawing. In addition,a fee of 565.00 made payable to the City of Northampton for each device application must be submitted to the D.P,W,before any application will be processed. A permit form the plumbing inspector may be necessary for the installation of these devices. Approvals or denials of this application will be seat directly to the owner. lf you have any questions, please call the Department of Public Works at 413-587-1570, Official DPW use only: Approval:_2: _t1 Ci— 7er 0 Denial:__,